Abstract
Background:Several studies have shown that restrictive transfusion policies are safe. However, in clinical practice, transfusion policies seem to be inappropriate. In order to assist in decision-making concerning red blood cell transfusions, we determined perioperative hemoglobin (Hb) levels during major pancreatic and hepatic operations.Methods:Patients who underwent major pancreatic or hepatic resections between 2002 and 2011 were classified into the transfused (TF+) and non-transfused (TF) groups. The perioperative Hb values of these patients were evaluated at six points in time.Results:The study included 1596 patients, of which 785 underwent pancreatoduodenectomy, 79 total pancreatectomy, and 732 partial hepatectomy. Similar perioperative changes in Hb levels were seen in all patients regardless of whether they received a blood transfusion. In patients undergoing pancreatoduodenectomy and total pancreatectomy, the median of the lowest measured hemoglobin values was 89.2 g/L and in partial hepatectomy patients 92.6 g/L, and these were assumed to be the trigger points for red blood cell transfusion.Conclusions:Despite guidelines on blood transfusion thresholds, restrictive blood transfusion policies were not observed during our study period. After major pancreatic and hepatic surgery, Hb levels recovered without transfusions. This should encourage clinicians to obey the restrictive blood transfusion policies after major hepatopancreatic surgery.
Highlights
Red blood cell transfusion (RBCT) is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs
In a cohort of 26,827 patients undergoing HPB surgery, 25.7% received RBCT1, while in a recent meta-analysis on post-pancreatectomy hemorrhage, the incidence of hemorrhages ranged from 3% to 16% 2
We examined the perioperative Hb level behavior during major hepatic and pancreatic resections in patients who received a blood transfusion (TF+) and in those who did not (TF−)
Summary
Red blood cell transfusion (RBCT) is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. In a cohort of 26,827 patients undergoing HPB surgery, 25.7% received RBCT1, while in a recent meta-analysis on post-pancreatectomy hemorrhage, the incidence of hemorrhages ranged from 3% to 16% 2. In order to assist in decisionmaking concerning red blood cell transfusions, we determined perioperative hemoglobin (Hb) levels during major pancreatic and hepatic operations. In patients undergoing pancreatoduodenectomy and total pancreatectomy, the median of the lowest measured hemoglobin values was 89.2 g/L and in partial hepatectomy patients 92.6 g/L, and these were assumed to be the trigger points for red blood cell transfusion. After major pancreatic and hepatic surgery, Hb levels recovered without transfusions. This should encourage clinicians to obey the restrictive blood transfusion policies after major hepatopancreatic surgery
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